Critical Review of the Scientific Evidence and Recommendations in COVID-19 Management Guidelines

Jiaxing Xie; Zhufeng Wang; Jingyi Liang; Huimin Lin; Zhaowei Yang; Yingzhi Wang; Hanwen Liang; Hongkai Wu; Ruchong Chen; Younger Ou; Fengyan Wang; Yuan Wang; Yan Wang; Weizhan Luo; Jianheng Zhang; Naijian Li; Zhengtu Li; Mei Jiang; Shiyue Li; Jing Li

doi:10.1093/ofid/ofab376

Critical Review of the Scientific Evidence and Recommendations in COVID-19 Management Guidelines

Open Forum Infect Dis. 2021 Jul 14;8(8):ofab376. doi: 10.1093/ofid/ofab376. eCollection 2021 Aug.

Authors

Jiaxing Xie¹, Zhufeng Wang², Jingyi Liang², Huimin Lin¹, Zhaowei Yang¹, Yingzhi Wang³, Hanwen Liang², Hongkai Wu², Ruchong Chen¹, Younger Ou², Fengyan Wang², Yuan Wang², Yan Wang², Weizhan Luo², Jianheng Zhang², Naijian Li¹, Zhengtu Li², Mei Jiang², Shiyue Li², Jing Li¹

Affiliations

¹ Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
² National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
³ Department of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Abstract

Background: Little is known about the quality and potential impacts of the guidelines for coronavirus disease 2019 (COVID-19) management.

Methods: We systematically searched PubMed, Web of Science, Cochrane Library, guideline databases, and specialty society websites to evaluate the quality of the retrieved guidelines using the Appraisal of Guidelines for Research and Evaluation II.

Results: A total of 66 guidelines were identified. Only 24% were categorized as "recommended" for clinical practice. The 211 identified recommendations for COVID-19 management were classified into 4 topics: respiratory support (27), acute respiratory distress syndrome management (31), antiviral or immunomodulatory therapy (95), or other medicines (58). Only 63% and 56% of recommendations were supported by, respectively, assessment of the strength of the recommendations or level of evidence. There were notable discrepancies between the different guidelines regarding the recommendations on COVID-19 management.

Conclusions: The quality of the guidelines for COVID-19 management is heterogeneous, and the recommendations are rarely supported by evidence.

Keywords: COVID-19; evidence; guideline; management; recommendation.

Publication types

Review